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Rabeprazole and Psychiatric Symptoms

Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo," Messina, Italy

Paola Cutroneo, PhD

Resident in Clinical Pharmacology, Department of Clinical and Experimental Medicine and Pharmacology, University of Messina

Adele Gallo, PharmD

Local Health Authority No. 2, Department of Pharmacy, Caltanissetta, Italy

Salvatore Gallo, MD

Local Health Authority No. 1, Department of Internal Medicine, S. Giacomo D'Altopasso Hospital, Agrigento, Italy

Edoardo Spina, PhD

Professor of Clinical Pharmacology, Department of Clinical and Experimental Medicine and Pharmacology, University of Messina; Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo"

Achille P Caputi, PhD

Professor of Clinical Pharmacology, Department of Clinical and Experimental Medicine and Pharmacology, University of Messina; Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo"

Reprints: Dr. Polimeni, Section of Pharmacology, Department of Experimental and Clinical Medicine and Pharmacology, University of Messina, Torre Biologica—Policlinico Universitario, Via Consolare Valeria—Gazzi, 98125 Messina, Italy, fax 39 090 2213300, gpolimeni{at}unime.it

OBJECTIVE: To report the case of a patient who developed marked anxiety associated with episodes of panic attacks after starting rabeprazole therapy.

CASE SUMMARY: An otherwise healthy 55-year-old woman was prescribed rabeprazole 20 mg/day administered in the morning for persistent symptoms of dyspepsia. Ten days later, she presented with a 7 day history of marked anxiety associated with panic attacks, night terror (pavor nocturnus), episodic mental confusion, and attention deficit. Within 2 days of discontinuing rabeprazole, the patient recovered completely from the neuropsychiatric manifestations. Subsequent esomeprazole therapy did not cause psychiatric symptoms.

DISCUSSION: Rabeprazole-induced hypergastrinemia may have played a role in this neuropsychiatric adverse reaction. Several lines of evidence have indicated that gastrin-releasing peptide, whose release is mediated by proton pump inhibitor (PPI)-induced secretion of gastrin, is involved in regulating aspects of behavior that might be altered in disorders such as anxiety, depression, and dementia. The fact that rabeprazole has the highest capacity of inducing gastrin increase compared with other PPIs might explain why our patient's panic symptoms disappeared after switching to esomeprazole. Based on the Naranjo probability scale, rabeprazole was the probable cause of the adverse reaction.

CONCLUSIONS: Specific studies are needed to investigate the potential role of PPI-induced hypergastrinemia in neuropsychiatric adverse reactions.

Key Words: anxiety, hypergastrinaemia, panic disorder, rabeprazole

Published Online, July 3, 2007. www.theannals.com, DOI 10.1345/aph.1K134